Solicitation 36C24220Q0987 (Word version).docx

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C24220Q0987 08-07-2020 MILLS, BRAD | William.Mills4@va.gov

914.737.4400 x2074 08-21-2020

5:00 PM

36C242 Department of Veterans Affairs Network Contracting Office 2 James J. Peters VA Medical Center 130 West Kingsbridge Road Bronx NY 10468-3904 X X 541219 $22 Million N/A X See Statement of Work

36C242 Department of Veterans Affairs James J. Peters VA Medical Center Network Contracting Office 2 130 West Kingsbridge Road Bronx NY 10468-3904

Tungsten Network http://www.tungsten-network.com/us/en /veterans-affairs

See CONTINUATION Page This requirement is for Remote Coding Services for Health Information Management System (HIMS) medical coding at the VISN 2 South locations identified in the Statement of Work.

The result of this solicitation will be an Indefinite Delivery Requirements Contract, for a period of a year with 4 option years, as follows:

Base Year: 10/01/2020 through 09/30/2021 Option Year 1: 10/01/2021 through 09/30/2022 Option Year 2: 10/01/2022 through 09/30/2023 Option Year 3: 10/01/2023 through 09/30/2024 Option Year 4: 10/01/2024 through 09/30/2025 See CONTINUATION Page X X X

BRAD MILLS

Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C242 BRAD MILLS | William.Mills4@va.gov

Department of Veterans Affairs Network Contracting Office 2 James J. Peters VA Medical Center 130 West Kingsbridge Road Bronx NY 10468-3904

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly [ ]

b. Semi-Annually [ ]

c. Other [X] Monthly

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

Tungsten Network http://www.tungsten-network.com/us/en /veterans-affairs

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

B.2 STATEMENT OF WORK

Title of Project: VISN 2 South HIMS Remote Coding Support (Health Information Management Service)

Background: The Veterans Health Administration (VHA) currently captures and stores information including diagnoses, treatment, and providers for all inpatient and outpatient care provided to patients treated at a VA healthcare facility, and for patients treated at other healthcare facilities at the VA’s expense. All VA facilities store this information in an integrated computer system called “Veterans Health Information Systems and Technology Architecture” (VistA). Each facility has its own VistA database and selected data from the local databases is uploaded into various national systems.

Inpatient information is stored in the Patient Treatment File (PTF), which was developed in 1983. PTF is a computerized abstract of each patient discharge and contains over 100 different data items which describe the characteristics of the patient and the reason for the hospital stay. PTFs are completed for inpatients treated at any level of a VA facility (hospital, nursing home, domiciliary, observation), and for patients receiving care at non-VA facilities at VA expense. The PTF software package is subject to change with additions, modifications, deletions, etc. of the transaction types and data fields or replacement to meet data collection needs. See Attachment A for current PTF transaction types.

Outpatient information is entered through VistA Patient Care Encounter (PCE), Event Capture (EC) or Appointment Manager (AM) software modules. Coded data for all professional services – inpatient or outpatient – are captured through PCE. Some of the data elements are the date and time of service, identification of the provider, diagnoses and procedures for all care provided including ancillary services, minor and major procedures, and diagnostic studies.

The value of coded data to managers and researchers depends on how accurately it portrays the actual clinical events that take place in the medical center. Data validity begins with practitioners providing timely and complete medical record documentation including an accurate recording of all diagnoses and procedures.

Beginning September 1, 1999, CPT-4 procedure coding and inpatient Diagnosis Related Groups (DRGs) became a basis for facility and professional charges for bills submitted to third party carriers. Coders are held responsible for the accuracy of these codes and compliance with federal legislation and VHA guidelines.

Episodes of care to be coded include outpatient encounters, ancillary services, major and minor surgery, diagnostic studies, inpatient PTF, and/or inpatient professional services.

Statement of Need

The Veteran Integrated Service Network 2 (VISN 2) has a requirement for Remote Coding Services for all downstate VISN 2 Medical Center Campuses and CBOCs. Our objective is to maximize collections and meet VISN 2’s short and long-term revenue objectives. As a result, the purpose of our requirement is to ensure all bills are sent to the third-party carriers for non-service-connected care in a timely fashion. The Contractor will be utilized to avoid backlogs during staff vacations and illnesses, therefore increasing revenue. The Contractor will code cases provided to them by the facility under the direction of the Facility Chief Health Information Management Section (HIMS), or designee.

The Contractor shall receive work electronically from each VISN 2 Downstate facility. Workload for coders will be provided via NUANCE. NUANCE is an off-the-shelf national product utilized by all VA facilities. Facilities have the option to put the assigned work into a specific Shared Folder for use by the Contractor. The Business Office Automated Data Processing Application Coordinators (ADPAC) or IRM staff will assist when necessary.

The protection of that data is of utmost importance, thereby, both the VISN facilities and the Contractor must employ encryption software and the Contractor must not release data except for the purposes of this contract. All Contractor personnel must be required to observe the requirements imposed on sensitive data by law, HIPAA, Federal regulations, and VA policies and procedures. The Contractor must complete appropriate screening of their employees per VA requirements. The Contractor must be responsible for their employees (including subcontractors, if any) in the release of confidential/proprietary information and the divulgence to authorized recipients designated by the VISN facilities. All Contractor employees must have had background investigations performed prior to beginning work for the VA. The VA Information Security Officer will be furnished a copy of the background investigation. Information Security forms will be furnished to the Contractor for completion by their employees.

Scope of Work

Our purpose is to obtain medical coding services for the purpose of assigning ICD, CPT-4, and HCPCS codes based on medical record documentation of outpatient and inpatient care provided by the VISN 2 Downstate Medical Centers and providing coding audits. The contractor shall provide all resources necessary to accomplish the deliverables described in the statement of work (SOW), except as may otherwise be specified.

· Assign ICD, CPT-4, and HCPCS codes based on medical record documentation of outpatient and inpatient care provided at the VISN 2 Downstate Medical Centers.

· Furnish validation of the integrity, quality, and assignment of codes to the data contained in the outpatient Patient Care Encounter (PCE), inpatient Patient Treatment File (PTF), and the non-VA database.

The vendor will receive the coding cases from each VA Facility on an as needed basis. The contract will be open ended and temporary contract staff will be called upon as needed. The cases provided will be coded in NUANCE by Certified Coders, as well as scrubbed utilizing the NUANCE coding software. Upon completion of cases, they will be retrieved by the facility from the NUANCE system.

Schedule and Reporting Requirements

The Contractor will be responsible for providing the following types of personnel to work remotely on an as-needed basis.

1. Certified Coders/Coding Specialists (certified CCS, CCS-P, CPC, COC, CIC for all the VA Medical Centers listed, depending on the VA need.

a. It is the responsibility of the VA designated Contracting Officer’s Technical Representative (COR)/Business Manager to provide the Coding Specialist with the list of visits the Medical Center wants coded. The Coding Specialist will make necessary changes to ICD, CPT, and HCPCS codes in the NUANCE coding product or any other product per the facility contact person.

b. The Coding Specialist will work with the VA designated COR throughout this project. The Medical Center staff will provide the contractor with VISTA system training and any required coding related software and computer packages if deemed necessary.

2. Qualifications:

a. Individuals must have certification CCS-P, CPC, CCS, COC, CIC and at least 2-5 years of VA Hospital experience. Individuals must be knowledgeable in areas specific to the coding profession and be able to utilize a personal computer (PC).

b. Knowledge of Privacy Act for patient privacy is essential. Contract employees must be able to work independently.

c. Certified Coder must be able to work independently without supervision; ability to code 100 or more records per day based on received workload.

3. Contractor and all temporary employees will comply with The Joint Commission (TJC), HIPAA, and VA Medical Center Regulations.

4. Coding cases shall be completed or suspended with a valid reason within 72 hours of receipt by the Contractor.

Deliverables

All deliverables shall be forwarded to each VISN facility for acceptance. Invoices shall be provided to each facility by the vendor at a minimum of once per month. Payment will only be provided based upon work produced.

Performance Period

The VISN 2 Downstate Facilities anticipate an Indefinite Delivery Contract with options, consisting of a one-year base period and four one-year option periods. Funding will be provided by annual task orders.

Place of Performance:

All work shall be performed at the Contractor’s facility unless otherwise specified and mutually agreed to by the Contractor. This contract is for remote services.

Key Assumptions:

1. Industry standard coding guidelines shall be followed.

2. All patient encounters shall be properly coded.

3. Both physician and non-physician providers are employed by the VA Medical Center.

4. As a federal facility, providers must have valid licenses; however, VHA does not require providers to be licensed by the state in which they work.

5. The VA does not currently bill Medicaid.

6. VA submits billing to Medicare for a determination of benefits only; to facilitate billing to Medicare secondary payers; including supplemental benefit policies.

7. VA submits billing to private insurance carriers, including managed care plans with which VA hold a provider agreement.

8. The Contractor shall provide for its staff laptops, reference materials, software/encoder tools for conducting reviews and developing training materials. Contractor staff shall be proficient in the use of the laptops, reference materials, software/encoder tools and provide with their proposal evidence of use of an encoder.

9. VHA policies and procedures shall be followed. If the Contractor is uncertain concerning a policy, the Contractor shall consult with the appropriate VA Facility COR for clarification.

10. Failure of the Contractor to maintain the required 95% coding accuracy level may result in termination of the contract.

Contracting Officer Representative (COR):

Each Facility will have an assigned COR. Once the contract is awarded, the name and contact information of the COR for each facility listed below will be provided to the Contractor.

VA New York Harbor Healthcare System (Manhattan Campus) 423 East 23rd Street New York, NY 10010

VA New York Harbor Healthcare System (Brooklyn Campus) 800 Poly Place Brooklyn, NY 11209

VAMC Northport 79 Middleville Road Northport, NY 11768

Bronx VAMC – James J Peters Medical Center 130 W. Kingsbridge Road Bronx, NY 10468

VA Hudson Valley Healthcare System 2094 Albany Post Road Route 9A; PO Box 100 Montrose, NY 10548

General Requirements:

1. All written deliverables shall be phrased in layperson language. Statistical and other technical terminology shall not be used without providing a glossary of terms.

2. The latest United States editions of the International Classification of Diseases (ICD, Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT) of the American Medical Association (AMA), and the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA); shall be used to provide uniform disease and operation terminology which is complete and scientifically accurate.

3. Code assignment shall be in accordance with national Center for Health Statistics (NCHS), Centers for Medicare and Medicaid Services (CMS), American Hospital Association (AHA), AMA and APA guidelines, as appropriate. On those occasions where there is a question, VHA guidelines take precedence. Local policies will direct how coding is accomplished and what quantitative and/or qualitative reviews are performed. The AHA Coding Clinic and other publications may be used for training and reference purposes.

4. Contractor shall ensure that its staff members providing services under this statement of work (SOW) and pursuant agreement (TASK ORDER) use VA encoder software (NUANCE).

5. Contractor shall adhere to all coding guidelines as approved by the Cooperating Parties (The four organizations that make up the Cooperating Parties for the ICD, American Hospital Association (AHA), American Health Information Management Association (AHIMA), Centers of Medicare and Medicaid Services (CMS) and National Center for Health Statistics (NCHS) and accepted VA regulations, including:

6. The Official Guidelines and Reporting as found in the CPT Assistant, a publication of the American Medical Association for reporting outpatient ambulatory procedures and evaluation and management services,

7. The current Official Guidelines for Coding and Reporting in the Coding Clinic for ICD-10-CM and ICD-10-PCS, a publication of the American Hospital Association, and VHA guidelines for coding as found in the current versions of VHA Coding Guidelines and VHA HIM Clinical Coding Program Guide. Contractor shall ensure it has the current version and the guidance is followed.

NOTE: While VHA does ask for reimbursement from third party payers, the VHA coding policy is to code only according to coding guidelines. Our own compliance audits use only this definition when determining if any encounter or PTF is correctly coded.

8. Assignment of Evaluation and Management codes must assure documentation substantiates the code level assigned.

9. VHA Directive 1082, Patient Care Data Capture March 24, 2015

10. VHA Handbook Resident Supervision 1400.1

11. Other directives that VA may issue from time to time.

12. Upon request of the Contracting Officer, the Contractor shall remove any Contractor staff that do not comply with VHA policies or meet the competency requirements for the work being performed.

13. Contractor shall abide by the American Health Information Management Association established code of ethical principles as stated in the Standards of Ethical Coding, published by AHIMA.

14. All coding and auditing activities shall utilize the VA’s electronic health record.

15. Contractor shall provide all labor, materials, transportation, and supervision necessary to perform coding validation reviews for inpatient, observation, diagnostic tests, ambulatory surgery/medicine procedures and outpatient (clinic) data collection, evaluating the completeness and accuracy of coding diagnoses and procedures in accordance with official coding guidelines (Coding Clinics, CPT Assistant, AMA, Ambulatory Patient Classifications (APC) in a simulated Medicare payment environment.

16. Communication: Contractor shall specify a contact person and phone number who is available for personal contact at a minimum during regular business hours of the facility that owns the work, for the duration of the work. Contractor shall maintain frequent communications with the HIMS Manager or other designated medical center employee (i.e., coding supervisor/team leader) regarding progress, workload status and/or problems. The contractor shall make every effort to ensure that issues raised by the local facility are addressed in a timely manner.

17. Contract coders shall code in accordance with CCI Bundling Guidelines where appropriate. Contract coders must exclude coding information such as symptoms or signs characteristic of the diagnoses, findings from diagnostic studies, or localized conditions, which have no bearing on current management of the patient or as appropriate. Contract coders must clarify conflicting, ambiguous, or non-specific information appearing in the record by consulting with their supervisor who will, if necessary, discuss with the local VA contact.

18. Contractor is responsible for becoming familiar with guidelines on coding within the Veterans Health Administration (VHA).

19. The Contractor shall not use “incident to” rules.

20. Contractor shall code using CPT for inpatient professional services or nursing home professional services.

21. The Contractor shall furnish certification of Indemnification and Medical Liability Insurance in accordance with VAAR 852.237-7 to the Contracting Officer’s Technical Representative (COR), before commencing work under this contract, that coverage required has been obtained and such policy shall state “This Policy May Not Be Changed or Cancelled Without Written Notice To The VA”. Said policy must bear an appropriate “loss payable clause” to the United States as its interest may appear. Such evidence of insurance is not waived.

22. The Contractor shall possess all licenses, permits, accreditation and certificates as required by law. The Contractor shall perform the required work in accordance with The Joint Commission (TJC), Veterans Health Administration (VHA), and other regulatory standards. TJC standards may be obtained from:

The Joint Commission One Renaissance Blvd Oakbrook Terrace, IL. 60181

23. If the Contractor should find it necessary to reassign a staff member from working for a facility, the Contractor shall make arrangements for there to be a minimum of two week overlap when both the old and new staff member shall be working the facility’s account, unless there is a mutual agreement between the Contractor and facility that the overlap is not necessary.

24. Contractor is responsible for the management of its staff, and the Contractor is responsible for training its staff on VA policy and procedures.

25. Contractor staff shall sign confidentiality statements as required. Any person, who knowingly or willingly discloses confidential information from the VA, may be subject to fines.

Specific Mandatory Tasks and Associated Deliverables:

Contractor shall provide the specific service and deliverables described below within the timeframes identified or as agreed to on individual task orders.

Task One – Post Award Planning:

The contractor shall provide a work plan, briefing, and kick-off meeting for the government, which presents the Contractor’s plan for completing the task order. The plan shall illustrate this SOW and describe in further detail the approach to be used for each aspect of the task order as defined in its technical quotation. The Contractor shall schedule a kick-off meeting to be held within ten (10) business days of task order award or as agreed upon between local Contracting Officer and Contractor. At the kick-off meeting, the Contractor shall present the details of its intended approach, work plan and project schedule to include deliverable dates as applicable for review and approval by the VISN/VAMC. Work will not commence until the VISN/VAMC approves the approach and/or methodology, work plan and schedule. The Contractor shall also complete standard administrative tasks (e.g., background investigation forms, staff roster, mandatory training) as noted in the deliverable descriptions below.

Deliverable 1.1:

A project work plan in Microsoft Project or the VA approved project management software Primavera for Task 3 or Word document for Task 2 and briefing in Microsoft PowerPoint within ten (10) business days from date of award.

Deliverable 1.2:

Contractor shall submit to the local COR within five (5) business days after award a full and complete list of names, Social Security Numbers, and home addresses of Contractor personnel for the Background Investigation requirement.

Deliverable 1.3:

The Contractor shall complete and submit to the local COR a Staff Roster within five (5) business days from date of award.

Deliverable 1.4:

All mandatory training shall be completed and documented as appropriate within twenty (20) business days from date of award. If performance on this order crosses the anniversary date for recurring annual training requirements, such training must be completed within (20) business days of the anniversary date. Training completed by individual staff within the same fiscal year under separate orders as otherwise required for this deliverable will be accepted as long as appropriate documentation is submitted. Contractor shall submit electronically to the local COR within twenty-five (25) business days of award – or in the case of staff added after performance begins, twenty-five (25) business days of their on- board date- a complete status of training for all staff.

Task Two - Coding Services:

1. The Contractor shall use skills and knowledge of, ICD, CPT-4, HCPCS and other generally accepted available resources to review medical record documentation and provider’s scope of practice to assign diagnostic and procedural codes at an accuracy rate no less than 95%.

2. The Contractor shall code Outpatient Encounters including Radiology, Lab or other Ancillary Services, Surgical, Inpatient Professional Services; Inpatient Episodes/ Admission Services, as specified under each individual task order.

3. The Contractor shall abstract identified data items and either enter the data into the local VistA system, encoder program, or write the information on source documents as agreed with the local facility. This information shall include communication with CPAC (Consolidated Patient Accounting Center), that an episode of care may not be billable based on the documentation and VHA coding guidelines. This is communicated by coder comments and may include, at a minimum, treatment for a Service Connected (SC) condition, treatment related to Agent Orange (AO) exposure or Ionizing Radiation (IA), lack of attending documentation in a circumstance that requires it, telephone care, non-billable provider, or other types of care that could possibly be non-billable. Coding an episode of care includes answering any follow-up questions regarding the episode, including questions that may arise during the completion of a claim as well as developing responses to denials for payment or re-coding as necessary.

4. The Contractor shall provide all labor, materials, transportation and supervision necessary to perform coding and abstracting using Evaluation and Management guidelines designated by the facility on encounters and standard industry guidelines, e.g. Coding Clinics and CPT Assistant, as specified by the VAMC. Contractor shall adhere to all coding guidelines as approved by the Cooperating Parties and accepted VA regulations.

5. Utilize encoder and reference materials to assign and/or validate diagnostic and procedural codes reflective of documentation.

6. Utilize PCE/PTF/Surgery or other database, if necessary, to reflect code changes and name (s) of provider (s).

7. If requested by the facility, Contractor may place a local coder on-site if available in accordance with this contract when the coder lives in the area of a VA facility requesting work. No travel costs will be charged the Government in this scenario.

8. When assigning multiple CPT codes, the Contractor shall utilize the Correct Coding Initiative guidelines, ensuring that they are not components of a larger, more comprehensive procedure that can be described with a single code, and using modifiers as appropriate per these guidelines.

9. The Contractor shall identify those encounters, if any, where documentation does not substantiate an appropriate code (s).

10. The Contractor shall identify duplicate encounters or encounters created in error because the patient was not seen.

11. Contractor shall code based on reading and reviewing the documentation in the medical record including the Computerized Patient Record System (CPRS). The contractor shall complete data entry into the VistA system as part of this contract. Completion of source documents in lieu of VistA entry may be arranged only upon mutual agreement between the facility and the contractor.

12. For Inpatient Episodes/Admission Services, Contractor shall:

13. Complete all PTF Transition Types (101, 401, 501, 601, 701/702 and 801) in accordance with VHA HIM Clinical Coding Program Guide

14. Opening and re-transmitting PTFs shall follow local facility protocol

15. Contractor shall review documentation to determine why an ancillary or other diagnostic test was ordered and assigned an ICD diagnosis code to that test.

16. Contractor shall re-review any coded data when questioned by VA during the VA pre-bill process or when a denial is received to either make changes or substantiate the coding with appropriate coding rules and references. This service shall be included in the price of the work. Contractor shall use the following procedures and definitions during re-review processes:

Task Three – External Auditing Services:

1. External Audits of coded data shall be performed on any of the VHA required coding activities (e.g., inpatient, outpatient, ancillary). VHA uses the national coding guidelines, as mandated by HIPAA, provided by the authoritative sources: ICD - four organizations that make up the Cooperating Parties for the ICD; the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS.

2. These audits shall be performed separate from normal coding activities and shall conform to the individual task order requirements. These audits shall be based on compliance and address accuracy of coded data, health record documentation issues, process improvement and identify educational needs. Audit accuracy expectations are 95% and above and each audit will focus on one of the following: Inpatient facility (DRG) coding, Outpatient facility coding, Inpatient professional services including surgery, and Outpatient services which would include ER, Urgent Care, clinic visits, and Ambulatory Surgery. Audits shall consist of reviewing the following:

a. All diagnoses in the outpatient and inpatient setting- both facility and professional services

b. All procedures/services in the outpatient and inpatient setting-both facility and professional services

3. Reports shall be prepared to allow for use by medical center staff in re-reviews, education, or to provide management updates. All reviews shall utilize electronic auditing of the computerized medical record system (CPRS), whenever possible. Claims analysis and Non-VA records must be reviewed hardcopy. The reviews shall be conducted by remote data view. Should the information needed for audit, not be contained in CPRS or VistA, the medical center will scan the necessary documentation into the system, to facilitate an electronic record review.

4. Contractor shall provide a detailed project plan for each review to include:

a. Pre-audit prep call which outlines what will be needed by the auditors and/or HIM Chiefs

b. Specific timelines for completing review at each medical center

c. Timeframe for the facility reports and the consolidated network report

d. Number of reviewers for each medical center

5. Contractor shall review each facility’s HIMS policy and coding procedures prior to commencement of review.

6. Contractor shall develop a collection tool for all reviews and shall submit with its technical quotation a sample of the tool that will be used.

7. Contractor shall submit in its technical quotation the methodology for resolving coding questions by reviewers and ensuring inter-reviewer consistency and reliability.

8. Contractor shall review findings with the HIMS Chief, COR, Management, and other designated medical center personnel to review proposed changes prior to final written report for mutually agreed upon changes within 7 business days following the review (s). The Contractor shall submit the final written report of all findings and recommendations detailing accuracy, financial impact and areas of concern within 15 business days of completion of audit.

9. Weaknesses identified during the audit shall be used to provide education/training workshops using a “train the trainer” format. This can be done either on site or remote. As such the Contractor shall develop a facility specific training plan to present to VISN/VAMC Management officials, physicians/clinicians, sub-specialties if needed, and for HIM (coding) staff based upon the findings of the review within 7 business days following the review(s).

10. The Contractor shall conduct an exit interview/conference and education on all audit findings and recommendations with the Health Information Services Management and coding staff at the VA facility. If any “errors” are found, the contractor shall provide supporting documentation on why each is an error. This documentation should be developed with the expectation that the Contractor shall present the findings and the documentation to the VA staff as part of the training and education component of the audit.

Deliverable 3.1:

Detailed project work plan in Microsoft Project or the VA approved project management software Primavera and briefing in Microsoft PowerPoint within ten (10) business days from the date of award.

Deliverable 3.2:

Sample of an External Audit Report format within ten (10) business days from date of the award.

Deliverable 3.3: Review of audit findings/results with the HIMS Chief, Associate COR, Management, and other designated medical center personnel to review proposed changes within seven (7) business days following the audit.

Deliverable 3.4:

Facility specific training plan within seven (7) business days following the audit.

Deliverable 3.5:

Final written report of all findings and recommendations detailing accuracy (including documentation of all records reviewed), financial impact and areas of concern within 15 business days of completion of audit. An exit interview/conference may be requested by management officials at the discretion of the VISN/VAMC and will be coordinated with the COR for the facility, or designee.

Deliverable 3.6:

Contractor shall at minimum provide a two-hour educational session for coding staff. Vendor is required to develop specific coding education utilizing actual charts and identified coding issues specific to the coder and/or VA facility in accordance with timeline identified in approved training plan.

Reporting Requirements:

The Contractor shall provide the local COR with monthly progress reports commensurate with the length of the project unless otherwise indicated on the individual task order. The progress report shall cover all work completed during the preceding reporting period. This report shall also identify project activity, issues and resolutions, escalation process for outstanding issues, and remediation for any issues that cause the project to be delayed (both anticipated and unanticipated). The Contractor and VISN or VAMC shall mutually agree on the report format. The Contractor shall provide a sample of such report with its technical quotation. The Contractor shall also provide Quality Reports for Task 2.

Quarterly, the Contractor shall provide a summary report (Attachment B) to the National HIMS COR. This report covers only work referred to the vendor based on a contractual agreement through the TASK ORDER. The Contractor may propose modifications to the reporting requirements to the National COR.

Quality Control and Performance Metrics:

The HIMS Manager or VA appointed designee will validate the contractor’s work to confirm that contractual coding meets accuracy requirements. The contractor is responsible for its own work as outlined in this Quality Control section. Coding accuracy will be determined by the number of correct codes compared to total number of codes, correct DRG assignment, and correct review and data entry of identified data items. The contractor must maintain a 95% accuracy level. Failure to meet the required level of accuracy may result in termination of the TASK ORDER. The designated points of contact for the facility and the contractor will discuss any questions regarding coding or expected work.

The VISN/VAMC shall include the expected turnaround time on the individual Task Order. Work is considered completed when it is received back at the VA facility with data entry done via the encoder or the documentation is at the VA facility. When the contractor cannot meet this deadline, they must inform the VA facility contact person on or before the 10th business day.

The Contractor shall have in place the following Coding Quality Control/Performance Process whereby the Contractor shall:

a. Perform on-going quality assessment of not less than 5% of all coded data elements and provide weekly results to the VA facility to ensure that the 95% accuracy rate is met. Data elements include ICD codes, CPT-4 codes, HCPCS codes, DRGs and data items abstracted and entered by the contract coder. Contractor shall track results by coder to assure appropriate follow-up. Failure to report results within the specified period three times during a calendar year may result in termination of the TASK ORDER and/or task order.

b. If monitoring demonstrates that work has fallen below the quality standard, the contractor shall develop a corrective action plan and include it with the data.

Schedule for deliverables:

The contractor shall meet the Delivery Schedule for each deliverable specified on the approved project plan for the Task Order.

Changes to the Statement of Work:

Any changes to this SOW shall be authorized and approved only through written correspondence from the CO. A copy of each change will be kept in a project folder along with all other products of the project. Costs incurred by the Contractor through the actions of parties other than the CO shall be borne by the Contractor.

Government Responsibilities:

The government shall provide VA reference material as requested by Contractor.

As applicable, the VAMC shall provide space, worktables/desks and chairs, actual records (paper and /or electronic), PCs and limited access to VistA options when Contractor staff is onsite. However, this contract is for remote coding. Equipment and workspace for off-site coders is the responsibility of the contractor.

Contractor Experience Requirements:

The Contractor must provide experienced, competent, credentialed personnel to perform coding and/or auditing activities, per the criteria referenced in this Statement of Work. These are defined as key personnel and are those persons whose credentials were submitted. The Contractor agrees that the key personnel shall not be removed, diverted, or replaced from work without approval of the CO and COR.

Any personnel the Contractor offers as substitutes shall have the ability and qualifications equal to or better than the key personnel replaced. All requests for approval of substitutions in personnel shall be submitted to the COR and the CO within 30 calendar days prior to making any change in key personnel. The request shall be written, and the Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitution. The Contractor shall submit complete documentation of the qualifications for the proposed substitute and any other information requested by the COR needed to approve or disapprove the proposed substitution. The COR will evaluate such requests. The CO will notify the Contractor of approval or disapproval thereof in writing.

Contract Coders shall possess the ability to:

1. Read and interpret health record documentation to identify all diagnoses and procedures that affect the current outpatient encounter visit, ancillary, inpatient professional fees and surgical episodes.

2. Apply knowledge of current Diagnostic Coding (ICD) and Reporting Guidelines for inpatient and outpatient services.

3. Apply knowledge of CPT format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly.

4. Apply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in CPT.

5. Code in accordance with CCI Bundling Guidelines.

6. Use Healthcare Common Procedural Coding Systems (HCPCS), where appropriate.

7. Exclude from coding information such as symptoms or signs characteristic of the diagnoses, findings from diagnostic studies or localized conditions that have no bearing on current management of the patient.

Required Contract Coder Education and Experience:

1. Contract coders must have a minimum of 1-year coding experience in the area that they will be coding.

2. Contract Coders/validation staff must possess formal training in anatomy and physiology, medical terminology, pathology and disease processes, pharmacology, health record format and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD-9-CM, ICD-10-CM, HCPCS and CPT).

3. For the purpose of this contract, a certified coder is someone with one of the following active credentials. Other credentials shall not be accepted.

a. American Health Information Management Association (AHIMA) credentials as a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialists (CCS), and Certified Coding Specialist-Physician (CCS-P); or

b. American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) or COC or CIC

4. Supervisory Coders must have a minimum of 2-years’ experience in coding.

Property Rights, Confidentiality and Non-disclosure:

The contractor agrees that:

1. The preliminary and final deliverable and all associated working papers, application source code, and other material deemed relevant by the VA which has been generated by the contractor in the performance of this task order are the exclusive property of the U.S. Government and shall be submitted to the Contracting Officer at the conclusion of the task order.

2. The Contracting Officer will be the sole authorized official to release verbally or in writing, any data, the draft deliverables, the final deliverables, or any other written or printed materials pertaining to this Task Order. No information shall be released by the contractor. Any request for information relating to this task order presented to the contractor shall be submitted in writing to the Contracting Officer for response.

3. Press releases, marketing material or any other printed or electronic documentation related to this project, shall not be publicized without the written approval of the Contracting Officer. Additionally, the Contractor shall sign a National Business Associate Agreement (Attachment3) with the VA, in accordance with the HIPAA mandate after award. BUSINESS ASSOCIATE AGREEMENT: This contract requirement has been identified as requiring a Business Associate Agreement as defined in Health Insurance Portability and Accountability Act (HIPAA), Public Law 104-191. If Contractor has a signed national Business Associate Agreement (BAA) with the Department of Veterans Affairs, that copy shall be provided to the Contracting Officer for inclusion in the contract award. If the Contractor does not have a national BAA with the Department of Veterans Affairs, a local version will be provided to the Contractor for signature at time of award and will be closely similar to the template found in Solicitation Section D: Contract Documents, Exhibits, or Attachments. A completed copy shall be forwarded to the local VA Privacy Officer.

4. All individually identifiable health records shall be treated with the strictest confidentiality. Access to records shall be limited to essential personnel only. Records shall be secured when not in use. At the conclusion of the contract all copies of individually identifiable health records shall be destroyed or returned to VA. The contractor shall comply with the Privacy Act, 38 USC 5701, and 38 USC 7332 and HIPAA regulations.

Security and Privacy:

1. Information and Records

a. All information and records provided to Contractor by VA, in whatever medium, as well as all information and documents, including drafts, emails, back-up copies, hand-written notes and copies that contain such information and records gathered or created by Contractor (collectively referred to as “VA information”) in the performance of this contract, regardless of storage media, are the exclusive property of VA. Contractor does not retain any property interest in these materials and will not use them for any purpose other than performance of this contract.

b. Upon completion or termination of the contract, Contractor will either provide all copies of all VA information to VA or certify that it has destroyed all copies of all VA information as required by VA in a method specified by VA, at VA’s option. The Contractor will not retain any copies of VA information. Where immediate return or destruction of the information is not practicable, Contractor will return or destroy the information within 30 days of completion or termination of the contract. All provisions of this contract concerning the security and protection of the VA information that is the subject of this contract will continue to apply to the VA information for as long as the Contractor retains it, regardless of whether the contract has been completed or terminated.

c. Prior to termination or completion of this contract, Contractor will not destroy VA information received from VA or gathered or created by Contractor in the course of performing this contract without prior written approval by VA.

d. Contractor will receive, gather, store, backup, maintain, use, disclose and dispose of VA information only in accordance with the terms of this contract and applicable federal and VA information confidentiality and security laws, regulations and policies.

e. The Contractor shall not make copies of VA information except as necessary to perform this agreement or to preserve electronic information stored on Contractor electronic storage media for restoration in case any electronic equipment or data used by the Contractor to be restored to an operating state.

f. Contractor shall provide access to VA information only to employees, subcontractors, and affiliates only(1) to the extent necessary to perform the services specified in this Contract, (2) to perform necessary maintenance functions for electronic storage or transmission media necessary for performance of this contract, and (3) only to individual who first satisfy the same conditions, requirements and restrictions that comparable VA employees must meet in order to have access to the same VA information. These restrictions include the same level of background investigations, where applicable.

g. Contractor will store, transport or transmit VA information only in an encrypted form, using an encryption application that meets the requirements of FIPS 140-2, and is approved for use by VA.

h. Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor may use and disclose VA information only in two other situations: (i) in response to an order of a court of competent jurisdiction, or (ii) with VA’s prior written authorization. The contractor will refer all requests for, demands for production of, or inquiries about, VA information to VA for response.

i. If VA information subject to the contract includes information protected by 38 USC 7332, or 5705, include the following after the last sentence of the paragraph immediately above: Contractor shall not release information protected by either 38 USC 5705 or 7332 in response to a court order, and shall immediately refer such court orders to VA for response.

j. Prior to any disclosure pursuant to a court order, the Contractor shall promptly notify VA of the court order upon its receipt by the Contractor, provide VA with a copy by fax or email, whoever is faster , and notify by telephone the VA individual designated in advance to receive…